Cognitive training combined with aerobic exercise improves negative symptoms in recent-onset schizophrenia: Results from a 12-month randomized trial

Negative symptoms are often considered as a core feature of schizophrenia. High initial severity levels are predictive of poor clinical outcomes, and negative symptoms are often considered notoriously difficult to treat. However, some research indicates that combining cognitive training with aerobic exercise yields notable improvements in negative symptoms for individuals with multi-episode schizophrenia.

Our Randomized Controlled Trial (RCT) compared the impact of 12 months of Cognitive Training combined with Aerobic Exercise (CT&E) compared to Cognitive Training (CT) alone in 65 first episode schizophrenia patients (73% male; age = 22.5 years; education = 12.8 years). All participants were provided with cognitive training and the CT&E group also participated in an aerobic exercise program. Negative Symptoms were assessed with the SANS at baseline and subsequently every 2-weeks. Negative symptoms were secondary outcomes from our original RCT (Nuechterlein et al. 2023) and considered of high clinical relevance because of their relationship to functional outcome.

Piecewise Linear Mixed Effects Models showed an overall differential effect of treatment over 12 months in which the intervention groups improved at similar rates over the first 6 months, while the CT&E group continued to improve on SANS Total Score (p < 0.001). Similar patterns were observed on SANS Expressive and Experiential domains.

These findings indicate that aerobic exercise, when combined with cognitive training, can improve both expressive and experiential negative symptoms in individuals living with schizophrenia. The results extend the potential for exercise-based interventions to promote negative symptom reduction during a critical "early phase" that may impact long-term outcomes.